The Incidence of Life Threatening Vessel Injury Following Closed Reduction and Internal Fixation of Intertrochanteric Femoral Fractures

David Segal 1 Niv Marom 1 Eyal Yaacobi 1 Gabriel Bar Tal 2 Tal Nativ 1 Yaron S Brin 1
1Orthopedic Surgery, Meir Medical Center, Israel
2Radiology, Meir Medical Center, Israel

Introduction: For our knowledge the incidence of bleeding due to a vascular injury following intertrochanteric femur fractures was not evaluated since 1993. Our goal was to find the current incidence of this life threatening complication, to understand the reasons for this injury and to describe the presentation, diagnostic workup and treatment.

Materials and methods: We conducted a retrospective record review of patients that were operated at our institution due to AO31A femur fractures between 2011-2015 and were treated with closed reduction and internal fixation either with an intramedullary nail or a dynamic hip screw.

Results: The records of 1469 patients who sustained an intertrochanteric femoral fracture were reviewed. Four patients were post-operatively diagnosed with hip vascular bleeding, which constitute an incidence of 0.27%. Three patients were treated with an intramedullary nail and one with a dynamic hip screw. The patients presented with a post-operative significant hemoglobin level decline and an expanding hematoma and swelling of the operated hip. Three vascular injuries were detected as a profunda femuris arterial bleeding adjacent to the distal locking screw or medial to the sharp lesser trochanter bone fragments and one was related to an injury to the proximal superficial femoral artery. All patients were successfully treated with full recovery.

Conclusions: A vascular injury following an internal fixation of a proximal femur fracture is a rare complication. Despite its low incidence, this is a life threatening event and accordingly a high level of suspicion with an aggressive therapeutic approach are mandatory.